MAX BUPA REASSURE

• In-patient Care (Hospitalisation)

We cover cost of medical treatment when you or your insured family members are hospitalised for treatment.

• Day care treatments covered

We cover all day care treatments under the product.

• Alternative Treatments

We will indemnify the medical expenses incurred on the insured person’s hospitalization for Inpatient Care on treatment taken under Ayurveda, Unani, Siddha and Homeopathy.

• Domiciliary Hospitalisation

In case a bed in the hospital is unavailable or on advice of the attending medical practitioner, treatment is administered at home; we pay for medical treatment taken at home, which would otherwise have required hospitalisation. Such treatment should continue for at least 3 consecutive days and confirmation from treating medical practitioner/insured that insured person could not be transferred to the hospital or hospital bed was unavailable, as the case may be.

• Modern Treatments

We will indemnify the medical expenses incurred on the insured person’s hospitalization for Inpatient Care or as a part of Day Care Treatment for modern treatments like oral chemotherapy, deep brain stimulation, etc. There is a sub-limit of Rs. 1Lac on few robotic surgeries.

• Hospital Accommodation

No limit on the hospital room rent& ICU charges. They are covered up to Sum Insured.

• Pre & Post Hospitalisation Medical Expenses

We reimburse pre & post hospitalization medical expenses incurred due to illness/injury. The period of the treatment covered is 60 days before you get admitted to the hospital and 180 days after you get discharged from the hospital. This is subject to Niva Bupa accepting the In-patient Care hospitalisation, Day Care, Alternative Treatments or Modern Treatments claim.

• Organ Transplant

Medical expenses for an organ donor’s In-patient treatment for the harvesting of the organ donated is also covered provided the organ is for the use of the insured person.

• Emergency Ambulance

We also cover the road ambulance expenses to transfer the insured following an emergency to the nearest hospital. We also provide ambulance coverage if the medical condition requires immediate ambulance services from the existing Hospital to another Hospital with advanced facilities for management of the current Hospitalization. These expenses are paid up to Rs2,000 per hospitalization only if we have accepted anIn-patient or Day Care Treatment claim.

• Air Ambulance

We also cover costs incurred for ambulance transportation in an airplane or helicopter, for Emergency life threatening health conditions which require immediate and rapid ambulance transportation to the Hospital / medical centre that ground transportation cannot provide. Air Ambulance is covered up to Sum Insured for Cashless claim & up to Rs. 2.5 Lacs for Reimbursement claim.

• Home Care Treatment

We will cover Medical Expenses incurred on the Insured Person’s treatment taken at home for Chemotherapy or Dialysis, if these services are offered by a registered homecare provider.

• Booster Benefit

In case of claim free year, increase of 50% of expiring Base Sum Insured in a Policy Year; maximum up to 100% of Base Sum Insured (In case of a claim, reduction of accumulated Cumulative Bonus by 50% of expiring Base Sum Insured)

• ReAssure

Under this benefit unlimited reinstatements are provided for both same & different illness. It is triggered with the first paid claim itself and is available for all subsequent claims in a Policy Year. The maximum liability under a single claim under this benefit shall not be more than Base Sum Insured.

• Shared accommodation Cash Benefit

Daily hospital cash benefit for an amount of Rs. 800 per day; maximum Rs. 4,800 for Base Sum Insured upto 15Lacs (or Rs. 1,000 per day; maximum Rs. 6,000 for Base Sum Insured more than 15Lacs) will be provided if shared room accommodation is occupied in case of hospitalization in a network hospital. Minimum 48 hours of continuous hospitalization required, however claim would be paid from day one subject to hospitalization claim being admissible.

• Health Checkup

You can avail health checkup for Diagnostic Tests purposes from Day 1 for any insured person (including children), so that you live a healthier and happier life. You can choose tests from a pre-defined list up to a sub-limit as per the plan chosen. This benefit is available only once in a Policy Year and all tests must have been done on the same date.

• Second Medical Opinion

We also cover the costs for availing a second medical opinion for which we have accepted a claim under In-patient or Day Care Treatment hospitalization. This benefit can be availed only once during a Policy Year.

• Live Healthy Benefit

Discount on renewal premium will be provided basis number of steps taken.

• Personal Accident Cover (Optional)

Personal Accident coverage can be opted for any adult insured against accidental death, permanent total and partial disability.

• Hospital Cash (Optional)

Daily hospital cash benefit will be provided for an amount based on the Base Sum Insured chosen,in case of hospitalization. Minimum 48 hours of continuous hospitalization required, however claim wouldbe paid from day one subject to hospitalization claim being admissible. Maximum coverage offered for 30 days/policy year/insured person.

• Safeguard (Optional)

Below benefits will be provided under this optional cover:

1. Claim Safeguard: If We have accepted a Hospitalization claim, then the items which are not payable (please refer policy terms & conditions for the list) related to that particular claim will become payable.
2. Booster Benefit Safeguard: No impact on Booster benefit if claim in a policy year is less than Rs. 50,000
3. Sum Insured Safeguard: The Base Sum Insured will be increased on Cumulative Basis at each Policy Year on the basis of Consumer Price index (CPI) inflation rate in previous year published by the Central Statistical Organisation (CSO).

• Zonal Pricing

Premium will be based on your city of residence.

• Entry Age and family coverage

The entry age for adults under this policy can be from 18 to 65 years. The entry age for dependent children is from 91 days to 30 years in a family floater policy.

In an Individual cover, maximum up to 6 members (maximum of 4 adults and a maximum of 5 children) can be included in a single policy. Whereas, Family floater cover is available for maximum of 2 Adults and 4 children. Relationship allowed for adults is / are self, spouse, father, father in law, mother or mother in law.

• Tax Benefit

Save tax under Section 80D of the Income Tax Act when you buy a Niva Bupa health insurance policy. Tax benefits are subject to changes in the tax laws, please consult your tax advisor for more details.

• Assured Policy Renewal for Life

Once insured with us, you will always remain our customers subject to continued payment of premium. We assure you renewability for life with no extra loadings based on your claim history.

• Direct Claim Settlement

We believe you should focus on the treatment of your loved ones rather than running after claim settlement. Therefore, all claims are processed directly by our customer service team.

• Cashless Facility

Cashless Facility can be availed only at our Network Providers or Service Providers. Please contact us for more details.

• Free Look Period

We endeavor for transparency and complete satisfaction and therefore, our policies are transparent and easy to understand. If you are not satisfied, we provide a 15-day free look period (30 days if the Policy with Policy Period as 3 years has been sold through distance marketing)within which you can cancel your plan stating the reason.

• Information at your fingertips

Get quick and easy access to your claims history, your health information, your health profile, including records of tests and other details on our website.

The policy term is one or two or three years.

• Pre-existing disease waiting period of 36 months since inception of the policy and continuous renewal.
• Initial waiting period of 30 days unless the treatment needed is the result of an Accident.
• Specific waiting period of 24 months, since the inception of the first policy with us, for some listed illnesses, unless the condition is directly caused by Cancer (covered after Initial Waiting Period of 30 days) or an Accident (covered from day 1).
• Please do read more about the common exclusions in the policy terms& conditions.

• Investigation & Evaluation
• Rest Cure, rehabilitation and respite care
• Obesity/ Weight Control
• Change-of-Gender treatments
• Cosmetic or plastic Surgery
• Hazardous or Adventure sports
• Breach of law
• Excluded Providers
• Treatment for, alcoholism, drug or substance abuse or any addictive condition.
• Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private beds registered as a nursing home attached to such establishments or where admission is arranged for domestic reasons.
• Dietary supplements and substances that can be purchased without prescription unless prescribed by a Medical Practitioner as part of Hospitalization.
• Refractive Error
• Unproven Treatments
• Sterility and Infertility
• Maternity Expenses
• Charges related to a Hospital stay not expressly mentioned as being covered.
• Circumcision
• Conflict & Disaster
• External Congenital Anomaly
• Dental/oral treatment
• Hormone Replacement Therapy
• Multifocal Lens and ambulatory devices and any medical equipment which is used at home.
• Sexually transmitted Infections & diseases (other than HIV / AIDS)
• Sleep disorders
• Any treatment or medical services received outside the geographical limits of India.
• Any expenses incurred on OPD treatment.
• Unrecognized Physician or Hospital
• The condition which is not clinically significant or is related to anxiety, bereavement, relationship or academic problems, acculturation difficulties or work pressure.
• intentional self inflicted Injury or attempted suicide.
• neuro-developmental delays and disorders.
• Mental retardation.
• Artificial life maintenance for Person who has been declared brain dead or in vegetative state
• Hospitalization is not necessary or the stay at the Hospital is found unduly long
• Refer to the policy document for detailed permanent and personal accident cover exclusions.